Immunotherapy: How to Manage Side Effects

Immunotherapy uses your own immune system to kill cancer cells. While still not a cure for everyone, it’s a promising field. The newest types of immunotherapy drugs are called checkpoint inhibitors:

So far, these drugs are only approved for use in some cancers, including melanoma, and certain cancers of the lung, bladder, and head and neck. As more people use these treatments, the risk and frequency of side effects are becoming clearer.

What Should You Expect?

Traditional chemotherapy can cause hair loss and blood problems. But immunotherapy drugs don’t work in the same way. The most common side effects from them appear to be flu-like symptoms such as fever, achy muscles and joints, fatigue, and nausea. You might also have itchy skin, loss of skin pgmentation and diarrhea. Infections may also occur.

You might notice more serious side effects if your immune system goes into overdrive and starts to attack healthy tissues. This can lead to diabetes, and inflammation of your bowels, pancreas, and lungs. Rarely, there have been neurological problems such as Guillain-Barre syndrome and myasthenia gravis, and even fatal reactions from heart attack, lung toxicity, and liver injury.

How Are They Treated?

Most side effects often go away in a few days. In general, drugs that help suppress the immune system, such as steroids, can help. If the symptoms are too severe, your doctor may pause your treatment for a while. But if you have a life-threatening reaction, you’ll need to stop treatment.

Topical corticosteroid creams and oral antihistamines can often give quick relief for skin symptoms. Over-the-counter treatments should work for mild diarrhea as well.  

High-test steroids like prednisolone or other drugs that suppress your immune system are also the choice to treat most other problems, which you may hear your doctor refer to as adverse events, or AEs. You might get mycophenolate mofetil, a drug that transplant patients take to prevent their immune systems from attacking the new organ, if the treatment leads to inflammation of an organ like your liver (hepatitis) or pancreas (pancreatitis). Diabetes can be treated with insulin.

When Should I Call the Doctor?

Early diagnosis is a key way to help avoid major problems, so tell your doctor right away if you have unusual symptoms.

Everyone’s different, so there’s no rule for when side effects will show up. Skin problems can appear 2 to 3 weeks after the first dose of the drug, gastrointestinal problems may take 6 to 7 weeks, and endocrine problems may not affect you for more than 2 months. Some people don’t have side effects until months after treatment ends.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on December 12, 2018

Sources

SOURCES:

European Journal of Surgical Oncology: “Immunotherapy in melanoma: Recent advances and future directions.”

American Cancer Society: “Immune checkpoint inhibitors to treat cancer,” “Immunotherapy for melanoma skin cancer.”

Dana-Farber Cancer Institute: “What Are the Side Effects of Immunotherapy?”

BioMed Central: “Immune related adverse events associated with anti-CTLA-4 antibodies: systematic review and meta-analysis.”

Melanoma Research: “Two cases of clinical myasthenia gravis associated with pembrolizumab use in responding melanoma patients.”

Trends in Immunology: “Autoimmune Cardiotoxicity of Cancer Immunotherapy.”

UpToDate: “Toxicities associated with checkpoint inhibitor immunotherapy.”

Melanoma International Foundation: "Melanoma Treatment: Stage IV."

European Journal of Cancer: “Cutaneous, gastrointestinal, hepatic, endocrine, and renal side-effects of anti-PD-1 therapy.”

European Society for Medical Oncology: "Managing the Side Effects of Novel Cancer Immunotherapeutics."

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